Russian Pediatric OphthalmologyRussian Pediatric OphthalmologyРоссийская педиатрическая офтальмология1993-18592412-432XEco-Vector62926410.17816/rpoj629264Original study articleОригинальные исследованияResearch ArticleInfluence of various factors on the efficiency of trabeculectomy in pediatric patients with congenital glaucomaВлияние различных факторов на эффективность трабекулэктомии у детей с врождённой глаукомойhttps://orcid.org/0000-0002-8938-29434875-6288ArestovaNataliya N.АрестоваНаталия Николаевна
Russian Federation

MD, Dr. Sci. (Med.)

доктор медицинских наук

arestovann@gmail.com7396-8551ArestovDmitry O.АрестовДмитрий Олегович
Russian Federation

MD, Cand. Sci. (Med.)

кандидат медицинских наук

arestovann@gmail.comhttps://orcid.org/0000-0003-2103-15709930-4813PanovaAnna Yu.ПановаАнна Юрьевна
Russian Federation

MD, Cand. Sci. (Med.)

кандидат медицинских наук

annie_panova18@mail.ruHelmholtz National Medical Research Center of Eye DiseasesНМИЦ глазных болезней им. ГельмгольцаN.A. Semashko Scientific and Educational Institute of Clinical Medicine of the Russian University of MedicineНаучно-образовательный институт клинической медицины им. Н.А. Семашко Российского университета медицины1406202419259722003202425032024Copyright ©; 2024, Eco-VectorCopyright ©; 2024, Эко-Вектор2024Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://ruspoj.com/1993-1859/article/view/629264

AIM: The study aimed to analyze the influence of various factors on the efficiency of trabeculectomy in pediatric patients with congenital glaucoma.

MATERIAL AND METHODS: The results of 945 trabeculectomies, including those with various modifications and the use of drains, in pediatric patients with congenital glaucoma were analyzed in the Department of Pediatric Eye Pathology of the Helmholtz National Medical Research Center for Eye Diseases for 1997–2023.

RESULTS: The efficiency of trabeculectomy in pediatric patients with congenital glaucoma was 91.9%–98.5% in the immediate period (up to 6 months) after surgery, 75.5%–86.5% in the long term (after 5 years), and 34.2%–42.1% with repeated surgeries (up to 3–4 surgeries) during follow-up up to 10 years, which is comparable with literature data.

CONCLUSION: The main factors that influence the efficiency of trabeculectomy in pediatric patients with congenital glaucoma include age at the time of detection and surgical treatment of congenital glaucoma, their somatic health, glaucoma stage, and severity of destructive changes in the eye, particularly the congenital ones, presence of repeated surgeries, erroneous choice of the trabecular site subject to excision during surgery, injury rate of trabeculectomy (quality of incision of the conjunctiva, sclera, injury rate of vessel coagulation during surgery, and skill of the surgeon), presence of intra- and postoperative complications, untimely detection and YAG laser elimination of the internal fistula fusion after trabeculectomy, and inadequate management of the postoperative period.

Цель. Анализ влияния различных факторов на эффективность трабекулэктомии у детей с врождённой глаукомой.

Материал и методы. Проведён анализ результатов 945 трабекулэктомий (ТЭ), в том числе с различными модификациями и применением дренажей, у детей с врождённой глаукомой в отделе патологии глаз у детей НМИЦ глазных болезней им. Гельмгольца за период 1997–2023 гг.

Результаты. Эффективность трабекулэктомии у детей с врождённой глаукомой в ближайшие сроки (до 6 месяцев) после операции составляла 91,9–98,5%, в отдалённые сроки (через 5 лет) — 75,5–86,5%, при повторных операциях (до 3–4 операций) в течение наблюдения до 10 лет — 34,2–42,1%, что сопоставимо с данными литературы.

Заключение. Основными факторами, влияющими на эффективность трабекулэктомии у детей с врождённой глаукомой являются следующие: возраст детей на момент выявления и хирургического лечения врождённой глаукомы, их соматическое здоровье, стадия глаукомы и тяжесть деструктивных изменений глаза, особенно врождённых, наличие повторных операций, ошибочный выбор участка трабекулы, подлежащей иссечению при операции, травматичность выполнения трабекулэктомии (качество разреза конъюнктивы, склеры, травматичность коагуляции сосудов в ходе операции, мастерство хирурга), наличие интра- и послеоперационных осложнений, несвоевременное выявление и ИАГ-лазерное устранение заращения внутренней фистулы после трабекулэктомии, неадекватное ведение послеоперационного периода.

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